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Eur Heart J. 2018 Jan 7;39(2):102-110. doi: 10.1093/eurheartj/ehx491.

Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease.

Author information

Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Blegdamsvej 9, Copenhagen, Denmark.
Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Copenhagen, Denmark.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Kildegårdsvej 28, 2900 Hellerup, Denmark.
Department of Cardiology, Nykøbing Falster Hospital, University of Southern Denmark, Fjordvej 15, 4800 Nykøbing Falster, and Odense, Denmark.
Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr 52, 20246 Hamburg, Germany.



We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD).

Methods and results:

We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with non-obstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population.


STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.


Causes of death; Non-obstructive coronary artery disease ; ST-elevation acute coronary syndrome ; ST-elevation myocardial infarction ; Survival


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